Thyroid Dysfunction in Patients With Chronic Kidney Disease: The State of the Problem and the Ways of Solving

Abstract

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney disease is the higher incidence of various thyroid function disturbances, especially hypothyroidism. It is known that in patients with chronic kidney disease (CKD) iodine excretion from the body is violated, since normally 90% of iodine is excreted in urine. Accumulation of high concentrations of inorganic iodine leads to the formation of the Wolf-Chaikoff effect: suppression of iodine organization in the thyroid gland and disruption of the thyroid hormones synthesis. Peripheral metabolism of thyroid hormones is also disturbed, namely, deiodinase type I activity is suppressed and peripheral conversion of T4 into T3 is inhibited (so-called low T3 syndrome). Therefore, patients with CKD are often diagnosed with hypothyroidism, and the origin of hypothyroidism is not always associated with the outcome of autoimmune thyroiditis. The article presents an overview of a large number of population studies of thyroid gland dysfunction in patients with CKD, as well as experimental data specifying the pathogenetic mechanisms of thyroid dysfunction in patients with CKD. Therapeutic tactics are still not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.